| NPI | 1073981684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0009675) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000971) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4198) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2025-01-31 |